HomeMy WebLinkAboutBuilding Permit Application �I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: n, Permit Number: ✓ ��
'RECEIVED
CIA UNITY
Building Permit Application FEB 09 1021
Planning and Development Services Permitting Departme
St.LVcl Co . .
Building and Code Regulation Division C01111'i'tefdal Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ;��15 '1�� �a��QsflaProperty Tax ID#: - (,.�C�1 ��a� "' c��.�7J '.c7Qy 2'S Lot No.
Site Plan Name: LIQ_taiL0� Block No.�O
Project Name:
DETAILED DESCRI.PTION.OF;WORK::.;:;
New Electrical Meter Second Electrical Meter
ICONSTRUCTI.ON-INFORNAAT:ION.*' ' I _
Additional work to be performed under-this permit—check all that apply:
_Mechanical _Gas Tank Gas Piping Shutters _Windows/Doors _Pond
Electric _Plumbing. _Sprinklers _Generator LA(oof Z Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ( 143gc) = utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: ;CON OR:,,
Name_ G Z Na
Address: "1���5` ZF�_o�R AA_%P_, Com 10
City: _4;;T_CrtAt -Stater) Address:
Zip Code:.342, / Fax: City:1C 1..'e1'e.,e, Stater
Phone No. Zip Code -Fax:.')'7�— ,A 02�
E-Mail: Phone No 469 -o.>�a te'
� E �(� -'
Fill in fee simple Title Holder on next page(if different E-Mail, 1 �C G wt ca�,�G i •V&c�c,,A
from'the Owner listed above) State or County License
If value of construction is 2500 oi more,a RECORDED Notice of Commencement Is required. , 1
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. �,�V l I
SUP.PLEIVIENTAL CONSTRUCTIO'N LIEN LAW.1NF0'RIVIATI'ON:: "
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ,Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
lil
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _;Not Applicable
Name: Name'
Address: Address:
City! City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration.of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and-accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing,consult-
witblenderoran attorneV before commencing wo ing your Notice of Commencement.
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wner essee/Contractor as Agent for Owner tgna e /License o er
LORIDA STATE OF FLORID
COUNTY OFF COUNTY OF
Swop to(or affirmed)and subscribed before me of Sw to(or affirmed)and subscribed before me of
P sical Pres ce 44r Online Notarization P stcai Presen or Online NotarizatiQ
this day of ,t� this day of 2G216by 11
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Name of person making statement. Name of person making statement.
Personally Known y OR Produced Identification Personally Known y OR Produced Identification
Type of Identification Type of Identification
Produ d Produced
G
11 1h ill Or Sr_e�%
(Signature of No ry P - (Signature of Notaryd�RCY 3
rv�"v
v? s Commission No. =� MY ,'_ YC .",.ICommission No. b1
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW - REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
COMPLETED
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